改良翼点入路手术对颅脑创伤患者神经功能及预后的影响

Influence of improved pterion approach on nerve function and prognosis of craniocerebral trauma patients

目的探讨改良翼点入路手术对颅脑创伤患者神经功能及预后的影响。方法选择杭州市大江东医院2014年7月至2016年7月收治的颅脑创伤患者100例作为研究对象,根据不同手术方式分为两组,每组50例。对照组予传统手术入路治疗,观察组予改良翼点入路手术治疗。观察两组患者的神经功能、安全性及预后。结果两组患者治疗前神经功能缺损程度评分(NDS)及格拉斯哥昏迷指数(GCS)评分差异均无统计学意义(t=1.03、0.98,均P>0.05)。治疗后,两组NDS评分均较治疗前显著降低(t=5.62、7.23,均P<0.05),两组GCS评分均较治疗前显著提高(t=3.46、4.75,均P<0.05),且观察组NDS评分为(13.72±5.42)分,较对照组的(20.72±6.51)分显著降低(t=4.32,P<0.05),观察组GCS评分为(11.25±2.63)分,较对照组的(8.42±1.35)分显著提高(t=3.27,P<0.05)。对照组并发症发生率为48%(24/50),显著高于观察组的18%(9/50)(χ^2=7.36,P<0.05)。对照组病死率为32%(15/50),显著高于观察组的16%(8/50)(χ^2=3.17,P<0.05),对照组恢复良好率为14%(7/50),显著低于观察组的28%(14/50)(χ^2=6.35,P<0.05)。治疗前,两组患者Spitzer指数差异均无统计学意义(t=1.01、0.98、0.92、0.98、0.87,均P<0.05),治疗后,两组患者Spitzer指数均显著高于治疗前(t=2.72、3.64、2.83、3.45、3.52、3.67、3.84、4.61、4.53、5.27,均P<0.05),两组比较,观察组Spitzer指数显著高于对照组(t=2.56、2.73、4.26、4.43、3.95,均P<0.05)。结论在颅脑创伤患者治疗中,实施改良翼点入路术治疗,其神经功能恢复优于传统手术,病死率及并发症发生率更低,安全性更好,提高患者生活质量,预后佳。

Objective To explore the effects of improved pterion approach on neurological function and prognosis of patients with craniocerebral trauma. Methods From July 2014 to July 2016, 100 patients with craniocerebral trauma admitted to Hangzhou Dajiang East Hospital were selected in this study, and they were divided into two groups according to different surgical methods, with 50 cases in each group.The control group was given traditional surgical approach, and the observation group was given improved pterion approach surgery.The neurological function, safety and prognosis of the two groups were observed. Results The NDS scores and GCS scores had no statistically significant differences between the two groups before treatment(t=1.03, 0.98, all P>0.05). After treatment, the NDS scores of the two groups were significantly reduced(t=5.62, 7.23, all P<0.05), the GCS scores of the two groups were significantly improved(t=3.46, 4.75, all P<0.05). The NDS score of the observation group was (13.72±5.42)points, which was significantly lower than that of the control group[(20.72±6.51)points](t=4.32, P<0.05). The GCS score of the observation group was (11.25±2.63)points, which was significantly higher than that of the control group[(8.42±1.35)points](t=3.27, P<0.05). The incidence rate of complications of the control group was significantly higher than that of the observation group[48%(24/50) vs.18%(9/50),χ^2=7.36, P<0.05]. The mortality rate of the control group was significantly higher than that of the observation group[32%(15/50) vs.16%(8/50),χ^2=3.17, P<0.05], and the recovery rate of the control group was significantly lower than that of the observation group[14%(7/50) vs.28%(14/50),χ^2=6.35, P<0.05]. Before treatment, there were no statistically significant differences in the Spitzer index between the two groups(t=1.01, 0.98, 0.92, 0.98, 0.87, all P<0.05). After treatment, the Spitzer index of the two groups were significantly higher than those before treatment(t=2.72, 3.64, 2.83, 3.45, 3.52, 3.67, 3.84, 4.61, 4.53, 5.27, all P<0.05), which of the observation group were significantly higher than those of the control group(t=2.56, 2.73, 4.26, 4.43, 3.95, all P<0.05). Conclusion The improved pterion approach in the treatment of patients with craniocerebral trauma has better neural functional recovery than traditional surgery, and it has lower mortality rate and complication rate, better security, and can encourage patients to improve the quality of life, and it has better prognosis.